Defining Risks for Endocarditis with Preexisting Cardiac Conditions

Knowing the relative risks for infective endocarditis (IE) associated with underlying cardiac diseases is essential in providing rational recommendations on preventing this infection. To define the relative 5-year risk for IE in patients with known preexisting cardiac conditions, investigators used data from the National Health Service in England from 2000 to 2013.

IE incidence in the general English population was 36.2 cases/million/year; IE-related mortality rate was 6.3/million/year. As expected, the respective odds ratios for developing IE or dying from it were greatly increased in patients with cardiac conditions considered high risk: 265.5 and 214.9 with prior IE, 70.1 and 62.0 with prosthetic valve replacement, 76.7 and 59.5 with valve repair with prosthetic material, 55.4 and 133.6 with unrepaired cyanotic congenital heart conditions (CCHCs), and 86.1 and 314.5 with CCHCs repaired with palliative shunt. However, respective odds were 18.3 and 24.4 for CCHCs repaired with prosthetic material. Also as expected, the respective odds with moderate-risk cardiac conditions were 51.4 and 54.5 with rheumatic fever, 41.5 and 35.9 with nonrheumatic valve disease, and 66.4 and 56.7 with congenital valve anomalies. Odds ratios for IE were 5.5 with heart transplant and 124.2 with prosthetic heart or ventricular assist device; IE-related deaths were not increased for these groups. Odds ratios for IE and IE-related death were 32.8 and 4.0 with hypertrophic cardiomyopathy and 9.7 and 10.1 with an implanted pacemaker or cardioverter.